One of Saint Barnabas Medical Center’s finest cardiothoracic surgeons explains the risk factors for aneurysm and the various cutting-edge aortic procedures he performs.
If a patient has to undergo a surgical procedure, he or she undoubtedly wants the best of the best doctor to perform it. That’s especially true if you need an operation on your aorta, which has the ever-important job of carrying blood from the heart to the rest of the body. Ioannis Loumiotis, M.D., cardiothoracic surgeon at Saint Barnabas Medical Center and Newark Beth Israel Medical Center, explains here the differences in the types of aortic surgeries, whether or not aortic aneurysm has genetic ties and the two highly specialized aortic operations he performs at RWJBarnabas Health.
Q: What are the most common types of aortic surgeries you perform?
A: I perform the entire spectrum of aortic surgery, including complex aortic valve repair, bicuspid valve repair, valve sparing root replacement, total arch replacement and thoracoabdominal aneurysm surgery. I perform both open (chest) and endovascular aortic surgery.
Q: What are the differences between these two methods?
A: In open surgery, we do an incision in the body, localize the aneurysm, resect the piece of the dilated aorta and replace it with a dacron graft that is basically a cloth material that has been used in cardiac surgery for decades. Alternatively, endovascular surgery makes use of catheters through a remote location, the groin for example, to deploy a stent graft to the aneurysm. However, not all patients and pathologies can be treated with either surgery, and there are numerous factors that a surgeon takes into account when deciding on the approach.
Q: What is the hospital stay and recovery like for each of these procedures?
A: The usual length of stay for open surgery is between 5 and 7 days. With endovascular surgery, which is a less invasive treatment, it’s usually 1-2 days shorter before discharge.
Q: Who is at risk for aortic aneurysm?
A: There are a lot of risk factors for developing an aneurysm, and many of them are like those causing heart attacks and heart failure. Patients with high blood pressure, atherosclerosis, smokers and those with certain autoimmune diseases are at high risk of developing aneurysms. If someone has a family history of an aortic aneurysm, he or she definitely has to get checked out. Studies have shown up to 20 percent of aneurysms have a familial component. There is also a genetic component in aneurysm formation. Certain connective tissue diseases like Marfan syndrome predispose patients to develop aneurysms at a younger age.
Q: If someone does have one of these genetic predispositions, can he or she still limit the chance of needing aortic surgery?
A: These are progressive diseases; once you have a stretch of the aorta it’s always stretched, but you can decrease the rate of stretching. Avoid smoking, control your blood pressure and the most important thing of all is to have regular checkups with your aortic surgery specialist. Aneurysms are a progressive disease and they need to be followed carefully by a specialist—both a surgeon and cardiologist—because they tend to grow. Every patient is different, and we always try to individualize treatments.
Q: What determines whether or not a patient needs surgery to treat their condition?
A: We know for a fact that there are specific thresholds that when they are met the patient needs surgery. The absolute aneurysm size is one of them, and when it reaches a specific size, the risk of complications like rupture, dissection or even death is significantly increased. Importantly enough, every patient is different and he/she could also have other risk factors, like rapid aneurysm growth, family history of aneurysms or a connective tissue disease that brings the threshold to intervene to lower levels. In our aortic program, we tailor our approach to each patient in order to achieve the best outcome.
Q: What are the symptoms of an aortic aneurysm?
A: Actually, the majority of patients with aneurysms (90-95 percent) are asymptomatic. Patients don’t know [if they have one] and usually only find out while undergoing imaging such as CT scans for other reasons. If they do develop symptoms, which may include chest pain, back pain or shortness of breath, this usually means the disease is quite advanced. We try to intervene beforehand by monitoring and operating sooner.
Q: What other aortic procedures do you perform?
A: Among others, I perform highly complex operations that are not really common and only a handful of surgeons can perform. The first is called valve-sparing root replacement. I perform this operation on patients who have an aortic root aneurysm and who need replacement of the aortic root, but I keep their own aortic valve. The benefits are that patients do not need to be on a blood thinner and they also have less of a chance of requiring another operation in the future since prosthetic valves can degenerate with time.
The second is highly complex thoracoabdominal aneurysm surgery, which may be performed via open and endovascular approaches. These are patients that have extensive aneurysms involving both the chest and abdominal aorta, a highly lethal condition if left untreated. The open surgical approach is especially beneficial for younger patients, those who have a connective tissue disorder or patients with a chronic dissection, which is essentially when the aorta dissects and degenerates over time.
Q: How do you work with other specialists at Saint Barnabas Medical Center to ensure the best for your patients?
A. Our team is composed of specialists not only in surgery but also cardiologists and experts in medical imaging. We take a multidisciplinary approach to this complex disease which is tailored to each patient’s unique pathology. We offer consultations and second opinions and we work together with the patient’s referring physician for the best patient outcome.
To learn more about aortic surgery or to schedule an appointment with Dr. Loumiotis, call 973.926.6938.